OUR VIEW: Who can solve Medicaid problem?

Published: Sunday, February 24, 2013 at 6:01 a.m.

Last Modified: Friday, February 22, 2013 at 4:45 p.m.

It’s worse when that problem concerns a state’s top expenditure from its General Fund and that is vital to a large chunk of its residents.

It’s downright horrible when the point at which that problem becomes a meltdown is just a year away.

Such is the state of Alabama’s Medicaid program, based on a presentation last week to legislative committees by Dr. Don Williamson, state health officer and interim director of the Alabama Medicaid Agency.

Williamson said it will take $615 million to adequately fund Medicaid for the current fiscal year. He predicted another $128 million would be needed in Fiscal 2014, whose budgets will be drawn up in this year’s legislative session, just to fund the program “at a minimal level.” He said those funds could be found through budgetary slicing and dicing.

After that? Williamson said there won’t be enough money to keep the program afloat, and he has no idea how to get more. In fact, when a legislator asked him if he had the answer to Medicaid’s perennial funding problems in Alabama, he responded point blank: “I cannot suggest that I can fix Medicaid.”

That had to be chilling news for low-income Alabamians who depend on Medicaid for their health care — and there are a lot of them.

Statistics for 2011 from the Alabama Medicaid Agency showed 22.3 percent of the state’s population overall and 46.9 percent of those under age 21 were eligible for the program, which paid out more than $5 billion that year. The numbers in Etowah County are even higher — 24.8 percent overall and 51.5 percent of young people.

Also according to the Alabama Medicaid Agency, half the births and two-thirds of nursing home care in the state is funded by the program.

Medicaid is a big deal — and a necessity — in Alabama.

Legislators who heard Williamson’s dire projections suggested things like raising co-payments for Medicaid patients or instituting a cigarette tax to help raise money for the state’s share of the program (it also receives federal money).

Williamson said he had no authority to do the former; the problem with the latter is the dreaded “T” word. There will be no massive new source of revenue to fix this.

We’re sure there will be pressure on Gov. Robert Bentley to reverse his opposition to expanding Medicaid in Alabama under Obamacare, as Gov. Rick Scott in Florida just did. It’s certainly tempting, but we still have issues with doing something to Medicaid as currently structured in Alabama that would add even more people to the program’s rolls and potentially leave the state scrambling again once the full federal subsidy expires.

A commission established by Bentley has proposed restructuring Medicaid using a managed care setup that has been successful in other states at reducing costs and ensuring quality care, and which we have said has potential. The hope is that it could be implemented by 2015.

<p>It's bad when there's a problem for which no one has a good solution.</p><p>It's worse when that problem concerns a state's top expenditure from its General Fund and that is vital to a large chunk of its residents.</p><p>It's downright horrible when the point at which that problem becomes a meltdown is just a year away.</p><p>Such is the state of Alabama's Medicaid program, based on a presentation last week to legislative committees by Dr. Don Williamson, state health officer and interim director of the Alabama Medicaid Agency.</p><p>Williamson said it will take $615 million to adequately fund Medicaid for the current fiscal year. He predicted another $128 million would be needed in Fiscal 2014, whose budgets will be drawn up in this year's legislative session, just to fund the program “at a minimal level.” He said those funds could be found through budgetary slicing and dicing.</p><p>After that? Williamson said there won't be enough money to keep the program afloat, and he has no idea how to get more. In fact, when a legislator asked him if he had the answer to Medicaid's perennial funding problems in Alabama, he responded point blank: “I cannot suggest that I can fix Medicaid.”</p><p>That had to be chilling news for low-income Alabamians who depend on Medicaid for their health care — and there are a lot of them.</p><p>Statistics for 2011 from the Alabama Medicaid Agency showed 22.3 percent of the state's population overall and 46.9 percent of those under age 21 were eligible for the program, which paid out more than $5 billion that year. The numbers in Etowah County are even higher — 24.8 percent overall and 51.5 percent of young people.</p><p>Also according to the Alabama Medicaid Agency, half the births and two-thirds of nursing home care in the state is funded by the program.</p><p>Medicaid is a big deal — and a necessity — in Alabama. </p><p>Legislators who heard Williamson's dire projections suggested things like raising co-payments for Medicaid patients or instituting a cigarette tax to help raise money for the state's share of the program (it also receives federal money).</p><p>Williamson said he had no authority to do the former; the problem with the latter is the dreaded “T” word. There will be no massive new source of revenue to fix this.</p><p>We're sure there will be pressure on Gov. Robert Bentley to reverse his opposition to expanding Medicaid in Alabama under Obamacare, as Gov. Rick Scott in Florida just did. It's certainly tempting, but we still have issues with doing something to Medicaid as currently structured in Alabama that would add even more people to the program's rolls and potentially leave the state scrambling again once the full federal subsidy expires.</p><p>A commission established by Bentley has proposed restructuring Medicaid using a managed care setup that has been successful in other states at reducing costs and ensuring quality care, and which we have said has potential. The hope is that it could be implemented by 2015.</p><p>We hope that's correct.</p>